Policies and Procedures for Home Health Services Department of Community Health 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Provider Name and Medicaid Provider Number at the top of the form. This information is essential for identifying your agency.
3. For the Cost Reporting Period, specify the start and end dates. Accurate dates ensure proper reporting.
4. In Section I, 'Visits by Discipline', input data from your agency's records for each discipline listed, including Skilled Nursing and Physical Therapy.
5. In Section II, 'Cost Information', enter total costs corresponding to each discipline as per CMS Form 2552 guidelines.
6. For Section III, 'Medical Supplies Billed to Patients', fill in total agency costs and Medicaid charges based on your records and CMS Form data.
7. Finally, ensure that an authorized officer or administrator signs the document, indicating approval and accuracy of the information provided.

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